创伤早期不同剂量氨甲环酸治疗急进高原兔创伤失血性休克的效果比较  

Comparative efficacy of different doses of tranexamic acid for traumatic hemorrhagic shock in the early phase of trauma following acute exposure to high altitude in rabbits

作　　者：刘圳 聂超 袁梨嘉 杨玲 蒋慧 钱程 蔡凌虎 张翼 刘明华 Liu Zhen;Nie Chao;Yuan Lijia;Yang Ling;Jiang Hui;Qian Cheng;Cai Linghu;Zhang Yi;Liu Minghua(Emergency Department,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院急诊科,重庆400038

出　　处：《中华创伤杂志》2025年第3期305-317,共13页Chinese Journal of Trauma

基　　金：军队专项科研课题(ZX2022XJ105)。

摘　　要：目的比较创伤早期不同剂量氨甲环酸(TXA)治疗急进高原兔创伤失血性休克(THS)的效果。方法25只健康雄性新西兰兔按随机数字表法分为平原对照组(5只)和急进高原THS组(20只),其中平原对照组全程不进行THS建模操作,急进高原THS组置于体积分数10%的低氧模拟仓内饲养3 d,即于仓内构建THS模型。根据急进高原THS建模后30 min静脉缓慢推注TXA剂量的不同,将急进高原THS组分为4个亚组:急进高原THS+0 mg/kg TXA组、急进高原THS+45 mg/kg TXA组、急进高原THS+90 mg/kg TXA组和急进高原THS+135 mg/kg TXA组,每组5只。分别在失血前、失血后30 min和失血后120 min记录兔的生命体征[平均动脉压(MAP)、心率、肛温]和血液样本中血细胞计数[红细胞计数(RBC)、血小板计数(PLT)]、凝血四项[纤维蛋白原(FIB)、D-二聚体、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)]、血栓弹力图参数[凝血反应时间(R值)、血凝块形成时间(K值)、血凝块最大强度(MA值)]、多配体蛋白聚糖-1(Syndecan-1)、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]和纤溶酶原激活物抑制剂-1(PAI-1);THS后6 h,取兔的肺、回肠末端和肾等组织观察组织损伤情况,并检测肺组织湿/干重比(W/D)和总含水量(TLW)。结果(1)生命体征:失血前,急进高原THS各组较平原对照组MAP、心率和肛温差异均无统计学意义(P>0.05);失血后30 min和120 min,急进高原THS各组较平原对照组MAP、心率和肛温均降低(P<0.05);急进高原THS各组间各时间点MAP、心率和肛温差异均无统计学意义(P>0.05)。急进高原THS各组内MAP、心率及肛温在失血后30 min和120 min时较失血前均降低(P<0.05),失血后120 min较失血后30 min均降低(P<0.05)。(2)血细胞计数:失血前,急进高原THS各组较平原对照组RBC均增加(P<0.05),PLT均减少(P<0.05)。失血后30 min,急进高原THS各组较平原对照组RBC差异均无统计学意义(P>0.05),PLT均降Objective To compare the efficacy of different doses of tranexamic acid(TXA)for traumatic hemorrhagic shock(THS)in the early phase of trauma following acute exposure to high altitude in rabbits.Methods Twenty-five healthy male New Zealand rabbits were randomly divided into plain control group(n=5)and acute high-altitude THS group(n=20)according to the random number table method.The plain control group did not undergo THS modeling throughout the experiment while the acute high-altitude THS group was raised in a hypoxia simulation chamber with a volume fraction of 10%for 3 days to establish the THS model.Based on the different doses of TXA administered intravenously at 30 minutes after THS modeling,the acute high-altitude THS group was further divided into four subgroups:acute high-altitude THS+0 mg/kg TXA subgroup,acute high-altitude THS+45 mg/kg TXA subgroup,acute high-altitude THS+90 mg/kg TXA subgroup and acute high-altitude THS+135 mg/kg TXA subgroup,with 5 rabbits in each.The vital signs[mean arterial pressure(MAP),heart rate,rectal temperature]and blood cell counts[red blood cell count(RBC),platelet count(PLT)],4 coagulation parameters[fibrinogen(FIB),D-dimer,activated partial thromboplastin time(APTT),prothrombin time(PT)],thromboelastography[clotting reaction time(R value),clot formation time(K value),maximum amplitude(MA value)],syndecan-1,inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and plasminogen activator inhibitor-1(PAI-1)were recorded before blood loss,at 30 minutes and 120 minutes after blood loss.At 6 hours after THS,the lungs,terminal ileum,and kidneys of the rabbits were collected to observe tissue damage,and the wet/dry weight ratio(W/D)and total water content(TLW)of the lung tissue were measured.Results(1)Vital signs:Before blood loss,there were no significant differences in MAP,heart rate,or rectal temperature between the acute high-altitude THS subgroups and the plain control group(P>0.05).At 30 minutes and 120 minutes after blood loss,the acute high-altitude TH

关 键 词：高海拔 休克 创伤性 出血 氨甲环酸 

分 类 号：R641[医药卫生—外科学] R594.3[医药卫生—临床医学] R973.1